Cellulitis resident survival guide
|Cellulitis Resident Survival Guide Microchapters|
Synonyms and Keywords:
Cellulitis is inflammation of deeper layers of the skin including the dermis and subcutaneous tissue. It is mostly due to bacterial infection. The bacteria invade the deeper layers after breaching the skin barrier. It usually involves the lower limbs. It presents clinically with signs of inflammation, i.e., redness, swelling, warmth, pain. The risk factors for cellulitis include a weakened immune system, diabetes, lymphatic obstruction, and varicose veins. It is treated conservatively with oral antibiotics in uncomplicated cases. Parenteral antibiotics are administered in patients with systematic symptoms and progressive lesions. Incision and drainage are done if discrete abscesses are present.
Life Threatening Causes
No known life-threatening causes are included.
- Streptococcus pyogenes
- Staphylococcus aureus
- Haemophilus influenza type B
- Streptococcus pneumoniae
- Neisseria meningitidis
|Perform compression Doppler ultrasound of the limb and D-dimers level|
|likely Deep vein thrombosis (DVT)||DVT unlikely. High clinical suspicion for cellulitis|
|Assess levels of inflammatory markers|
|Raised ESR, CRP and leukocytosis|
Does patient have any signs of rapidly progressive or systemic infection?
Perform the following tests:
|Is the cellulitis having a purulent discharge?|
Are there any of the following clinical signs?
Initiate intravenous antibiotic therapy. The coverage of the micro-organisms is determined by:
Initiate oral antibiotic therapy. The coverage of the micro-organisms is determined by:
Initiate antibiotics that cover both MRSA and gram negative rods. To cover MRSA:
Plus one of the following to cover for gram-negative rods
Infection most likely due to MRSA. Initiate
* Incision and drainage of discrete abscesses
|Assess patient's risk for infective endocarditis|
- Supportive care including elevation of the limb and adequate moisturizing of the site of the cellulitis should be done. The elevation of the limb promotes venous and lymphatic drainage from the site. Moisturize the affected site with emollients and moisturizers. It will hydrate the skin and prevent breakouts.
- Physicians should prescribe antibiotics to the patients according to body weight. Obese or lymphedema patients can be given a lower dose than their body weight. This results in inadequate response and failure of the treatment.
- The duration of antibiotic treatment is variable and depends upon the clinical improvement of the cellulitis. Mostly, there is significant improvement within a day or two after the initiation of the antibiotics. The patient is given treatment for five days. The antibiotic course is given for two weeks in patients with systematic symptoms, low immunity, and rapidly progressive cellulitis.
- Suppressive antibiotic therapy is administered to patients with three to four episodes of cellulitis per year with predisposing factors that can not be alleviated. Suppressive antibiotic therapy is directed against beta-hemolytic streptococci and staphylococci infection. Suppressive antibiotic therapy is not beneficial in patients with greater than three episodes of cellulitis in a year, chronic edema, and obese patients.
- Physicians should not perform incision and drainage for discrete abscesses in patients with high susceptibility of bacterial endocarditis without prior administration of the antibiotic. 2 grams oral amoxicillin should be given to the patient an hour before performing incision and drainage of the infected site.
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